General Council insists on retaining role as CMA's key policy-making body

In brief

Physicians attending the CMA's 129th annual meeting in Cape Breton, NS, in August rejected elements of a report that would have ended "cogovernance" and given sole responsibility for determining CMA policy to a 26-member Board of Directors, which would be accountable to an advisory General Council.

Instead, delegates affirmed their own power as the CMA's primary policy-makers. They said the Board of Directors should be an executive body that manages the association's business affairs and implements decisions made by General Council's more than 200 physicians, most of whom are selected by the CMA's provincial/territorial divisions and affiliated societies.

"General Council is the heart and soul of the CMA," said Dr. Derryck Smith, president of the British Columbia Medical Association. "Few divisions would bother to send delegates if they just came to give advice to the board."

The Committee on Structure had recommended changes that Dr. Rob Bartlett, its chair, said would have confirmed the working relationship that has evolved between the board and General Council. In recent years, instead of looking at policy details, the annual meeting has been used to debate pressing issues facing the profession and to offer clear advice and direction. The board, which meets five times a year and also holds several teleconferences, can quickly respond to government actions and represent the profession on complex issues requiring immediate attention.

"The committee attempted to identify appropriate roles for General Council and the board and reduce some of the liability now on General Council members," Bartlett said. "We're looking for clarity and efficiency of governance based on the fundamental concept of accountability."

Most delegates viewed the recommendation as an attempt to wrest power from General Council and disenfranchise the membership. "These changes would trivialize the role of General Council," said Dr. Alan McComiskey of Stephenville, Nfld.

"The members expect General Council to be their clout and give them direct input into decisions," another physician added.

The heated debate on who should set policy was led by eloquent opposition from British Columbia and Ontario. Bartlett was disappointed that the debate was so one-sided, since the committee had consulted extensively and believed its recommendation on governance would be endorsed by at least six divisions.

"There were three concerns we tried to address: good governance, law and political sensitivity," Bartlett said. "Perhaps our report should have been less driven by theory and more by political reality."

He thinks the debate convinced many that General Council would be emasculated, even though the description of its role would have allowed it to operate exactly as it has in recent years. He said the August decision has probably weakened the Board of Directors, which is now "fettered" with having every one of its decisions subject to General Council approval.

Bartlett said he accepts the political decision that was made, but many consequences need to be evaluated. "The decision on who would be the governing body was very clear, and the door to that discussion is now closed," he said. "But I had and have concern about what this decision means in law. The CMA may have the parliament of Canadian medicine, but it's still a corporation and has to operate like one."

Concerns that need to be evaluated include:

• Decision-making authority and liability: Given the magnitude of CMA's interests -- such as advocacy, lobbying, research, health promotion and the production of numerous goods and services for physicians -- can 200 or more delegates who meet three half-days a year conduct the business of a large corporation?

• Fiduciary responsibility: The responsibilities of voting members of an association generally include electing a management board and officers, giving advice and appointing auditors; they also could be responsible to others who elected them -- in the CMA's case, provincial/territorial divisions and affiliated medical societies. But delegates who come to General Council also exercise a policy-making function, and therefore have a fiduciary responsibility to the CMA, not to a constituency. This raises questions about the propriety of caucus solidarity.

• Accountability. As it stands, General Council is responsible to itself for policy-making. The Board of Directors, on the other hand, can back away from decision-making during the rest of the year in deference to the authority claimed by General Council.

• Representativeness. Although there appeared to be considerable interest in making General Council and possibly the Board of Directors more representative, the debate stalled on issues related to young physicians (see sidebar) and no decisions were made. Under-represented groups include affiliated societies, residents, students and medical women.

• Stability on the Board of Directors. The committee had recommended staggered, once-renewable terms that would be confirmed annually in an effort to ensure stability on the board, but the motion was defeated.

Where does the CMA go from here? What's left of the committee report and the decisions taken in Sydney have been referred to the board, which meets later this month. At that time, said Bartlett, the implications of these decisions will be debated and the committee's future discussed.

Committee membership may itself be an issue. Bartlett said the board intentionally struck a committee that was demographically representative of Canadian physicians -- balanced by sex, age, geography and political experience (it even included one physician who is not a CMA member) -- and that was not overburdened with bias about CMA traditions.

"The board may have second thoughts about the constitution of the committee," he said. "They may feel they need a more 'attached' group. Obviously we didn't change people's minds with a detached evaluation of what the CMA needs to be to do the best possible job of representing its members."

Another issue will be whether to delay a review of the CMA's advisory councils and committees, which was intended to be phase two of the committee's work. Bartlett said internal staff restructuring at the CMA may address some of the concerns.